Parul Rathor

Efficacy of noninvasive ventilation after planned extubation: A systematic review and meta-analysis of randomized controlled trials

The objective our meta-analysis is to update the evidence on the efficacy of noninvasive ventilation (NIV) compared with conventional oxygen therapy after planned extubation. We did a systematic literature review of database, including Pubmed, EMBASE, and Cochrane. We included randomized controlled trials comparing NIV with conventional oxygen therapy after planned extubation in medical intensive care unit (ICU) in our analysis. The results of our meta-analysis is consistent with the results of previous reviews and show that NIV decreased reintubation rate significantly as compared to conventional oxygen therapy in chronic obstructive pulmonary disease (COPD) and patients at high risk for extubation failure; COPD (RR, 0.33; 95% CI, 0.16-0.69; I2 = 0), high risk (RR, 0.47; 95% CI, 0.32-0.70; I2 = 0). However, in a mixed medical ICU population, there was no statistical difference of reintubation rate between the two groups (RR, 0.66; 95% CI, 0.25-1.73; I2 = 68%). Our study suggests that use of NIV after planned extubation significantly decreases the reintubation rate in COPD patients and patients at high risk for extubation failure, confirming the findings of previous reviews. There is no difference in the reintubation rate between the two groups in the mixed medical ICU population.

Safety and feasibility of PCI in patients undergoing TAVR: A systematic review and meta-analysis

Abstract We aimed to evaluate the safety and feasibility of PCI (percutaneous coronary intervention) for coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR) by performing a meta‐analysis. A systemic search of the database was performed. Studies were included comparing TAVR versus TAVR with PCI for significant CAD in patients undergoing TAVR for severe aortic stenosis. The primary outcome was 30 day mortality and secondary outcomes were myocardial infarction, stroke, life threatening bleeding, major access site vascular complications and renal failure. There were no significant differences in 30 day and six months‐one year mortality between TAVR and TAVR with PCI group. There were also no significant differences in myocardial infarction, stroke, and life threatening bleeding and major access site vascular complications between the two groups. PCI in addition to TAVR in patients with concomitant severe aortic stenosis and CAD is safe and feasible and does not increase procedural risk.

Acute Complications of Myocardial Infarction in the Current Era: Diagnosis and Management

Coronary heart disease is a major cause of mortality and morbidity worldwide. The incidence of mechanical complications of acute myocardial infarction (AMI) has gone down to less than 1% since the advent of percutaneous coronary intervention, but although mortality resulting from AMI has gone down in recent years, the burden remains high. Mechanical complications of AMI include cardiogenic shock, free wall rupture, ventricular septal rupture, acute mitral regurgitation, and right ventricular infarction. Detailed knowledge of the complications and their risk factors can help clinicians in making an early diagnosis. Prompt diagnosis with appropriate medical therapy and timely surgical intervention are necessary for favorable outcomes.

Impact of previous cardiac surgery on patients undergoing transcatheter aortic valve implantation: A meta-analysis.

The objective of our meta-analysis is to evaluate the impact of previous cardiac surgery in patients undergoing transcatheter aortic valve implantation (TAVI). We did a systemic search of databases, including Pubmed, EMBASE and Cochrane to identify relevant studies. We included studies comparing clinical outcomes in patients undergoing TAVI, with and without previous cardiac surgery. The 30 days as well as 1 year mortality was not significantly different between the two groups: 30 days (RR, 0.95; 95% CI, 0.82-1.09, I(2) = 0%), 1 year (RR, 0.94; 95% CI, 0.86-1.02, I(2) = 0%). The risk of acute myocardial infarction was significantly higher in patients with previous cardiac surgery and the risk of major vascular complications was lower in patients with previous cardiac surgery. Our meta-analysis suggests that the presence of previous cardiac surgery does not impair outcomes after TAVI, making this subset of patients particularly applicable for this evolving approach.

158: PROGNOSTIC IMPLICATIONS OF FEVER AFTER THERAPEUTIC HYPOTHERMIA

Learning Objectives: Therapeutic hypothermia (TH) or Targeted temperature management after cardiac arrest has been shown to improve survival as well as neurologic outcomes. Post hypothermia fever (PHF) after discontinuation of TH is a common occurrence, but the prognostic implications of PHF are unclear. We performed a meta-analysis of studies done in patients on TH after cardiac arrest to determine the prognostic value of PHF after TH. Methods: A Systematic search of Medline, EMBASE and Cochrane reviews was done by 2 reviewers using the text word “cardiac arrest” and “hypothermia”. Additionally, conference abstracts, review articles and bibliographies were searched. Studies were included if those were done in post cardiac arrest patients and TH was used after return of spontaneous circulation. PHF was defined as temperature > 38 or 38.5C within 24–96 hr after TH. A poor neurologic outcome was defined as Cerebral performance category scale of 3–5 or modified Rankin Scale of 3–6.The primary outcome was mortality (in hospital or 30 day). The secondary outcome was poor neurologic outcomes. A study level analysis was done using Review manager 5.2 (The Nordic Cochrane Centre, The Cochrane Collaboration, 2008). Results: Overall, six studies (5 full text and 1 abstract), including 1057 patients were included in the final analysis. Five studies reported mortality data. 48.3% patients died in the PHF group as compared to 44.6% in no fever group. There was no significant difference in mortality between two groups (odds ratio [OR], 1.33; 95% CI, 0.84 to 2.11, I2=57%).Five studies reported neurologic outcomes. There was no significant difference in neurologic outcomes between two groups (OR, 1.31; 95% CI, 0.86 to 2.00, I2=45%); however, after excluding one study which was a abstract, the heterogeneity becomes zero and PHF was associated with poor neurologic outcomes (OR, 1.62; 95% CI, 1.14 to 2.30, I2=0%). Conclusions: PHF after cardiac arrest is not associated with increased mortality but may be associated with poor neurologic outcomes. PHF may be useful for prognostication after therapeutic hypothermia.

Aortic Valve Endocarditis by a Rare Organism: Abiotrophia defectiva

Abiotrophia defectiva or nutritionally variant Streptococcus (NVS) is rare but important cause of infective endocarditis. We present a case of a 40 year old man with history of aortic valve replacement 14 years ago admitted for fever and chills. Blood culture grew A. defectiva in 4 out of 4 bottles. Patient became a febrile within few days after staring Ceftriaxone but subsequently had renal infarct due to septic embolization. Echocardiogram showed vegetations on aortic valve but no significant aortic regurgitation. After an 8 weeks course of Penicillin and Gentamicin was completed the patient had severe aortic regurgitation. Finally, aortic valve replacement and aortic root replacement was performed and patient did well after the surgery. Clinicians should be aware of this fastidious and aggressive organism when dealing with infective endocarditis. Complications rates are very high even on antibiotics and surgical treatment is needed in at least 50% of the cases.